RESUMEN

Abstract Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Asunto(s)

Humanos , Psoriasis/terapia , Terapia Ultravioleta , Vitíligo/terapia , Fototerapia , Neoplasias Cutáneas , Resultado del Tratamiento

RESUMEN

Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Asunto(s)

Psoriasis , Neoplasias Cutáneas , Terapia Ultravioleta , Vitíligo , Humanos , Fototerapia , Psoriasis/terapia , Resultado del Tratamiento , Vitíligo/terapia

RESUMEN

Introducción: Se ha establecido que la fototerapia con tecnología LED es más efectiva que la fototerapia convencional para el tratamiento de hiperbilirrubinemia neonatal al reducir el número de horas de tratamiento requerido en los recién nacidos a término y pretérmino. El objetivo del presente estudio fue realizar un estudio clínico aleatorizado con tres tipos de lámparas incluida una de prototipo. Métodos: En el presente estudio clínico con un diseño paralelo de tres grupos, participaron recién nacidos con necesidad de tratamiento por hiperbilirrubinemia, ingresados en la Unidad de Neonatología del Hospital Homero Castanier Crespo en Azogues-Ecuador. Fueron distribuidos en 3 grupos: Grupo 1 (G1) Fototerapia con lámpara fluorescente, Grupo 2 (G2) fototerapia LED comercializada (Medix®, Mediled®), Grupo 3 (G3) con Fototerapia LED de prototipo. Se mide la concentración de bilirrubinas y la diferencia de medias de su reducción en cada grupo para demostrar no inferioridad. Resultados: El peso en G1 (n=30) fue 3050 ±134 gr, en G2 (n=30): 3200 ±186; G3 (n=30): 3034 ±234 (P=0.70). La edad gestacional en G1: 39 ±1 semanas, en G2 39.1±1.1, en G3 39 ±1.1 (P=0.80). Bilirrubina en G1: 15.8 ±6.2, en G2: 14. 93 ±5.9 y en G3: 15.62 ±5.9 mg/dl. (P=0.60). Las diferencias de bilirrubina (Delta 1) pre-tratamiento y a las 24 horas de tratamiento fueron -2.4 en G1, -2.4 en G2 y -2.25 mg/dl en G3 (P=0.60). Delta 2 a las 48 horas: -4.5 en G1, -4.26 en G2 y -4.42 mg/dl en G3 (P=0.62). Conclusión: los tres tratamientos demostraron No inferioridad en el tratamiento de hiperbilirrubinemia neonatal

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Introduction: It has been established that phototherapy with LED technology is more effective than conventional phototherapy for the treatment of neonatal hyperbilirubinemia by reducing the number of hours of treatment required in term and preterm newborns. The objective of the present study was to carry out a randomized clinical study with three types of lamps, including a prototype. Methods: In the present clinical study with a parallel design of three groups, newborns with need of treatment for hyperbilirubinemia, admitted to the Neonatology Unit of the Homero Castanier Crespo Hospital in Azogues-Ecuador, participated. They were divided into 3 groups: Group 1 (G1) Phototherapy with fluorescent lamp, Group 2 (G2) commercialized LED phototherapy (Medix®, Mediled®), Group 3 (G3) with prototype LED phototherapy. The bilirubin concentration and the mean difference of its reduction in each group are measured to demonstrate non-inferiority. Results: The weight in G1 (n = 30) was 3050 ± 134 gr, in G2 (n = 30): 3200 ± 186; G3 (n = 30): 3034 ± 234 (P = 0.70). Gestational age in G1: 39 ± 1 weeks, in G2 39.1 ± 1.1, in G3 39 ± 1.1 (P = 0.80). Bilirubin in G1: 15.8 ± 6.2, in G2: 14. 93 ± 5.9 and in G3: 15.62 ± 5.9 mg / dl. (P = 0.60). The differences in bilirubin (Delta 1) pre-treatment and at 24 hours of treatment were -2.4 in G1, -2.4 in G2 and -2.25 mg / dl in G3 (P = 0.60). Delta 2 at 48 hours: -4.5 in G1, -4.26 in G2 and -4.42 mg / dl in G3 (P = 0.62). Conclusion: the three treatments demonstrated non-inferiority in the treatment of neonatal hyperbilirubinemia

Asunto(s)

Humanos , Fototerapia , Terapia PUVA , Recién Nacido , Hiperbilirrubinemia Neonatal

RESUMEN

Abstract: Background: Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective: In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods: A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results: When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations: Low number of patients Conclusion: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Asunto(s)

Humanos , Vaselina/farmacología , Fotoquimioterapia/métodos , Terapia PUVA/métodos , Enfermedades de la Piel/tratamiento farmacológico , Rayos Ultravioleta , Fármacos Fotosensibilizantes/farmacología , Emolientes/farmacología , Protectores Solares/farmacología , Factores de Tiempo , Pruebas Cutáneas , Método Simple Ciego , Reproducibilidad de los Resultados , Resultado del Tratamiento , Dermatitis Fototóxica/prevención & control , Estadísticas no Paramétricas , Relación Dosis-Respuesta en la Radiación , Aceite de Oliva/farmacología , Glicerol/farmacología

RESUMEN

La micosis fungoide es un linfoma cutáneo de células T de etiología desconocida que afecta principalmente a la población adulta. En sus fases iniciales la fototerapia sigue siendo una de las principales opciones terapéuticas. La terapia con NB-UVB en estadios tempranos IA-IB en parches y placas delgadas ofrece ventajas sobre el PUVA, debido a su mejor tolerancia y menores efectos secundarios; la terapia PUVA sigue siendo la elección en micosis fungoide en placas de mayor grosor. En cuanto a la terapia de mantenimiento se plantea que podría estar asociada a mayor radiación acumulada, sin lograr prevenir futuras lesiones, siendo el antecedente de recaída el principal factor predisponente para presentar nuevas lesiones en el futuro.

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Mycosis fungoides (MF) is a cutaneous T-cell lymphoma of unknown etiology that primarily affects the adult population. In early stages of the disease phototherapy is a major therapeutic option. At the time NB-UVB therapy in early stages IA-IB patchy and thin plaques offers advantages over PUVA, due to its better tolerance and fewer side effects, the PUVA therapy remains the choice to MF in thinner plaques. The maintenance therapy is posed that could be associated with higher accumulation of radiation without achieving prevents future lesions, being the history of relapse the main predisposing factor to present new lesions in the future.

RESUMEN

AbstractBACKGROUND:For years, phototherapy has been used in a wide range of skin diseases, which is unsurprising as skin is the anatomical feature most directly exposed to light, especially in psoriasis. Although the role of light therapy has been replaced by different therapeutic modalities in recent years, this treatment is now an established option for many skin diseases.OBJECTIVES:The aim was to characterize the patient population thathad received the aforementioned treatment in the Virgen Macarena Health Area in Seville (Spain) between June 1985 and October 2011.METHODS:We have designed a descriptive study with a univariate analysis covering 443 treatments with light therapy, all administered to the same number of patients suffering from psoriasis.RESULTS:79.15% of patients were discharged due to improvement or healing, while the 20.85% were discharged due to other reasons. The average total accumulative dose was 131.53 J/cm2. We do not detected an increase in proportion in patients for develop NMSK after light therapy treatment.CONCLUSIONS:We consider that phototherapy is still an effective and efficient treatment that will have to be reconsidered in the current macroeconomic context.

Asunto(s)

Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Psoriasis/radioterapia , Terapia Ultravioleta/métodos , Distribución por Edad , Hospitales de Enseñanza , Dosis de Radiación , Distribución por Sexo , España , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

O linfoma cutâneo de células T (LCCT) compreende um grupo heterogêneo de neoplasias de linfócitos T que se apresentam de diversas formas clínicas, histológicas, imunofenotípicas e evolutivas. Micose fungoide (MF) é a forma mais comum de LCCT e corresponde a 50% de todos os linfomas cutâneos primários. A variante hipocrômica da micose fungoide apresenta características epidemiológicas próprias, sendo rara em pacientes caucasianos, atingindo faixas etárias precoces, apresentando evolução na maioria das vezes benigna. O tratamento de eleição para MF é terapia direcionada à pele nos estágios iniciais, enquanto a terapia sistêmica fica reservada para os casos mais avançados. Dentre as terapias descritas, a fototerapia é um dos métodos mais utilizados atualmente para fases iniciais de MF pelos bons resultados apresentados e menor efeito colateral em relação aos demais. Recentemente muitos relatos têm mostrado que UVB-NB é efetiva para o tratamento de estádios precoces de MF. Descrevemos um caso de MF em uma adolescente no estágio IA da doença, apresentando resposta satisfatória com o tratamento com UVB-NB, duas vezes por semana.

RESUMEN

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Asunto(s)

Niño , Femenino , Humanos , Terapia PUVA/métodos , Trastornos de la Pigmentación/tratamiento farmacológico , Púrpura/tratamiento farmacológico , Telangiectasia/tratamiento farmacológico , Biopsia , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/patología , Trastornos de la Pigmentación/patología , Púrpura/patología , Dosis de Radiación , Resultado del Tratamiento , Telangiectasia/patología

RESUMEN

Primary cutaneous T cell lymphomas (CTCLs) are characterized by hyperproliferation of malignant CD4+ T cells with primary localization on the skin. The common characteristics are the migration of the malignant mature T-lymphocytes into the epidermis, with hyperproliferation of malignant CD4+ T cells and epidermotropism. Sézary syndrome (SS) is the leukemic variant. It was established that CTCLs arise from a clonal expansion of CD4+ T cells with an identical rearrangement of the T cell receptor. The purpose of this study was to evaluate the immunomodulation effect of photochemotherapy-A (psoralen plus ultraviolet A (PUVA)). Pre- and post-PUVA punch skin biopsies of nine patients were stained immunohistochemically for CD34+, CD8+, CD7+, CD16+, CD56+, CD1a+, Bcl2+, p53+, CD45RA+, and CD45RO+ cells. The results showed a pre-PUVA cells/mm(2) without significant difference among expansive or reactive cells. Post-PUVA analysis showed a significant decrease in the mean of expansive-reactive cells. PUVA immunomodulated decreasing cellular infiltrate. These findings could contribute to the comprehension of how PUVA acts. We achieved ectoscopic clearance of the lesions, although post-PUVA, there still was a mononuclear pathological infiltrate. This result demonstrates that the PUVA treatment should only be withheld when the histological analysis is normal.

Asunto(s)

Ficusina/uso terapéutico , Linfoma Cutáneo de Células T/tratamiento farmacológico , Terapia PUVA , Fármacos Fotosensibilizantes/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Linfocitos T/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Biopsia , Femenino , Humanos , Inmunofenotipificación , Linfoma Cutáneo de Células T/inmunología , Linfoma Cutáneo de Células T/patología , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patología , Linfocitos T/inmunología , Linfocitos T/patología , Resultado del Tratamiento

RESUMEN

BACKGROUND: PUVA-sol therapy has the advantage of its extensive availability and low cost. However, its use is empirical. The aim was to quantify the environmental UVA radiation and suggest a method for PUVA-sol administration. METHODS: we measured the UV radiation in the center of México (22 °N, 101 °W, 1877 m) by means of terrestrial radiometry from 2007 to 2011. We registered the variations according to hour, month, cloudiness and transmission through domestic silicate plates. RESULTS: more than 75 % of the UVA radiation is registered between the hours of 9:00 and 17:00. The annual lowest average intensity was 20 mW/cm(2) and the highest 25.4 mW/cm(2) (ANOVA, p < 0.001). The monthly UVA irradiation during the zenith for clear skies can be estimated by the following formula: 23.8 + 0.13 (month) - 0.13 (month - 6.5)(2), (r(2) = 0.95, p < 0.001). The commonly used silicate plate (3 mm) has a UVB absorbance of 0.93, and UVA transmittance of 0.58. CONCLUSIONS: the rational use of PUVA-sol is possible on the basis of the obtained data. It is necessary to isolate UVB radiation, and to adjust exposure during cloudy days, as well as following the safety protocol to obtain benefit and to reduce the risk of adverse effects.

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Introducción: la terapia PUVA-sol tiene como ventaja su disponibilidad y bajo costo. Sin embargo, su utilización es empírica. La finalidad del estudio es cuantificar la radiación solar UVA ambiental y sugerir una forma de administración en México. Métodos: se midió la radiación UV en el centro del país (22 °N, 101 °O, 1877 m) mediante radiometría terrestre de 2007 a 2011. Se registró la variación por hora, mes, nubosidad y transmisión a través de placas de silicato doméstico. Resultados: más del 75 % de la radiación UVA se registra entre las 9:00 y las 17:00 horas. La intensidad anual promedio mínima fue de 20 mW/cm2 y la máxima de 25.4 mW/cm2 (ANOVA, p < 0.001). El cálculo de irradiación UVA mensual durante el cenit bajo cielo despejado puede estimarse mediante la fórmula: 23.8 + 0.13 (mes) - 0.13 (mes - 6.5)2, (r2 = 0.95, p < 0.001). La placa común (3 mm) de silicato doméstico tiene una absorbancia UVB de 0.93 y una transmitancia UVA de 0.58. Conclusiones: es posible el empleo racional de PUVA-sol según los datos obtenidos. Es necesario aislar la radiación UVB y ajustar la dosis según la nubosidad, así como apegarse al protocolo de seguridad a fin de obtener beneficios y minimizar los efectos adversos.

Asunto(s)

Terapia PUVA , Luz Solar , Rayos Ultravioleta , Ambiente , Humanos , México , Dosis de Radiación , Radiometría

RESUMEN

The steady state and time resolved experiments together with absorption and emission spectroscopies and quantum chemical calculations have been employed to investigate spectroscopic properties of a xanthone-type compound (ethyl 3,12-dioxopyran[3,2-a]xanthone-2-carboxylate). The spectroscopic data show good agreement with results obtained from quantum chemical calculations. Additionally, this compound shows expressive quantum efficiency for triplet population and a quantum efficiency of singlet oxygen generation very close to unity. Correlations between the nature of singlet and triplet excited states and spectroscopic properties were performed in order to understand the high quantum efficiency of singlet oxygen generation by this compound.

Asunto(s)

Oxígeno Singlete/química , Xantonas/química , Absorción , Simulación por Computador , Electrones , Teoría Cuántica , Solventes , Espectrometría de Fluorescencia , Electricidad Estática , Termodinámica

RESUMEN

Vitiligo is a dreaded disease in India due to its social and cultural consequences. PUVA and PUVAsol are the main treatment modalities for vitiligo vulgaris. To the best of our knowledge, this is the first case of accidental PUVA burns eventuating in prurigo nodularis lesions to be reported in a female patient who was undergoing home PUVA therapy. The itch is so prominent and disabling that the focus of the patient has shifted from treating her vitiligo to ameliorating the pruritus.

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O vitiligo é uma doença temida na Índia por suas consequências sociais e culturais. As principais modalidades de tratamento do vitiligo vulgar são as terapias PUVA e PUVAsol. Pelo que sabemos, este é o primeiro relato de caso de prurigo nodular induzido por queimaduras acidentais por PUVA em paciente do sexo feminino em tratamento domiciliar com PUVA. O prurido é tão intenso e incapacitante que o foco da paciente passou do vitiligo à busca constante pela melhora do prurido.

Asunto(s)

Femenino , Humanos , Persona de Mediana Edad , Quemaduras/etiología , Terapia PUVA/efectos adversos , Prurigo/etiología , Vitíligo/tratamiento farmacológico , India , Vitíligo/patología

RESUMEN

BACKGROUND: Scleroderma is a chronic autoimmune disease characterized by progressive connective tissue sclerosis and microcirculatory changes. Localized scleroderma is considered a limited disease. However, in some cases atrophic and deforming lesions may be observed that hinder the normal development. Literature reports indicate phototherapy as a therapeutic modality with favorable response in cutaneous forms of scleroderma. OBJECTIVES: This study had the purpose of assessing the phototherapy treatment for localized scleroderma. METHODS: Patients with localized scleroderma were selected for phototherapy treatment. They were classified according to the type of localized scleroderma and evolutive stage of the lesions. Clinical examination and skin ultrasound were used to demonstrate the results thus obtained. RESULTS: Some clinical improvement was observed after an average of 10 phototherapeutic sessions. All skin lesions were softer at clinical palpation with scores reduction upon pre and post treatment comparison. The ultrasound showed that most of the assessed lesions presented a decrease in dermal thickness, and only five maintained their previous measure. Treatment response was similar regardless of the type of phototherapeutic treatment employed. CONCLUSIONS: The proposed treatment was effective for all lesions, regardless of the phototherapeutic modality employed. The improvement was observed in all treated skin lesions and confirmed by clinical evaluation and skin ultrasound.

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FUNDAMENTOS: A esclerodermia é uma doença autoimune caracterizada pela esclerose progressiva do tecido conjuntivo e alterações da microcirculação. A forma cutânea é considerada uma doença autolimitada. No entanto, em alguns casos, ocorrem lesões atróficas, deformantes, que dificultam o desenvolvimento normal. Relatos da literatura apontam a fototerapia como uma modalidade terapêutica com resposta favorável nas formas cutâneas da esclerodermia. OBJETIVOS: Este trabalho teve como objetivo avaliar o tratamento da esclerodermia cutânea com fototerapia. MÉTODOS: Foram selecionados pacientes com diagnóstico de esclerodermia cutânea para o tratamento com fototerapia, os quais foram classificados de acordo com o tipo clínico e o estágio evolutivo das lesões. Utilizou-se o exame clínico e a ultrassonografia da pele como metodologia para demonstrar os resultados obtidos com o tratamento proposto. RESULTADOS: Foi observado o início da melhora clínica das lesões com média de 10 sessões de fototerapia. A palpação clínica mostrou amolecimento em todas as lesões estudadas, com redução nos escores de avaliação estabelecidos. No exame de ultrassom, a maioria das lesões avaliadas mostrou diminuição da espessura da derme, e apenas cinco mantiveram sua medida. Não se observou diferença na resposta ao tratamento de acordo com o tipo de fototerapia instituída. CONCLUSÕES: O tratamento proposto foi efetivo em todas as lesões, independentemente do tipo de fototerapia realizada. A melhora foi observada em todas as lesões tratadas e comprovada pela avaliação clínica e pelo exame de ultrassom da pele.

Asunto(s)

Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Adulto Joven , Fototerapia , Esclerodermia Localizada/terapia , Piel , Terapia PUVA , Esclerodermia Localizada/patología , Piel/lesiones , Resultado del Tratamiento

RESUMEN

La psoriasis es una enfermedad inflamatoria crónica caracterizada por la hiperproliferación de queratinocitos como respuesta a la activación del sistema inmune. El manejo de esta patología es variado, pero las opciones terapéuticas disminuyen cuando la severidad aumenta, y hay que recurrir a medicaciones o terapias que traen mayores efectos secundarios no deseados. La fototerapia hace parte de los tratamientos utilizados en formas severas; la primera que se introdujo fue el uso de psoralenos más luz ultravioleta A (PUVA), pero es una terapia no del todo inocua que puede producir cataratas o inclusive cáncer de piel, lo que imposibilita su uso en algunos pacientes. Con el advenimiento de la terapia con luz ultravioleta B de banda estrecha (UVB-NB) en 1997, se abrió un nuevo espectro de alternativas de tratamiento para este tipo de pacientes, con similares características en cuanto a efectividad. Al comparar estos dos tipos de terapias, la literatura no es concluyente y deja un sinnúmero de dudas acerca de cuál de las dos terapias es más efectiva. Con la aparición de nuevas terapias, es importante conocer la más efectiva, pues son tratamientos menos costosos en comparación con los que están llegando al mercado.

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Psoriasis is a chronic inflammatory disease characterized by keratinocyte hyperproliferation in response to activation of the immune system. The management of this condition is varied, but the therapeutic options decrease as the severity increases, and we must resort to medications or therapies that bring more unwanted side effects. Phototherapy is part of the treatments used in severe forms, the first to be introduced was the use of psoralen plus ultraviolet A light (PUVA), but it is not entirely safe therapy that can cause cataracts or even skin cancer, which precludes their use in some patients. With the advent of light therapy narrow band ultraviolet B (UVB-NB) in 1997, it opened a new spectrum of treatment alternatives for these patients, with similar characteristics in terms of effectiveness. By comparing these two types of therapies, the literature is not conclusive and leaves a host of questions about which of the two therapies is more effective. With the advent of new therapies, it is important to know the most effective, they are less expensive treatments compared with those who are coming to market.

Asunto(s)

Rayos Ultravioleta , Ficusina

RESUMEN

FUNDAMENTOS: Formas moderada e grave de psoríase requerem fototerapia e/ou medicações sistêmicas. Tanto UVB banda estreita quanto fototerapia UVA com psoralênicos (PUVA) podem ser utilizadas no tratamento dessas formas de psoríase, sendo comprovada a efetividade de ambas as terapias. OBJETIVOS: Avaliar as indicações de dois tipos de fototerapia no tratamento da psoríase refratária à terapia tópica: UVB banda estreita e PUVA. MÉTODOS: Entre janeiro de 2006 e dezembro de 2007, os pacientes encaminhados a dois serviços de fototerapia foram incluídos neste estudo. Dados sobre os casos e tipos de prescrição foram coletados de maneira retrospectiva. RESULTADOS: Dentre os 67 pacientes estudados, 51 (76 por cento) foram tratados com UVB banda estreita. As razões para sua indicação foram presença de psoríase em gotas (22 por cento), presença de finas placas (15 por cento), uso de drogas fotossensibilizantes (15 por cento), idade abaixo de 20 anos (9 por cento), fototipo I (9 por cento) e doença hepática (6 por cento). Os 16 (24 por cento) restantes foram tratados com PUVA. A principal indicação dessa terapia foi gravidade da doença (15 por cento), seguida de fototipo IV (9 por cento). CONCLUSÕES: As prescrições de UVB banda estreita excederam as de PUVA devido ao menor número de contraindicações, menor possibilidade de efeitos colaterais, e ainda por ser uma opção mais prática.

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BACKGROUND: Moderate and severe forms of psoriasis require phototherapy and / or systemic medications. Both UVA and UVB can be used to treat cases of moderate and severe psoriasis, and the effectiveness of both has been proven. OBJECTIVE: to access the prescription behavior relating to two types of phototherapy for treating psoriasis refractory to topical treatment: narrowband UVB (NB-UVB) or psoralen plus UVA phototherapy (PUVA). METHODS: Between January 2006 and December 2007, patients referred to two phototherapy services were included in this study. Data on the cases and on the type of prescription were collected retrospectively. RESULTS: Among the 67 studied patients, 51 (76 percent) were treated with narrowband UVB. The reasons for the indication were the presence of the guttate type of psoriasis (22 percent), the presence of thin plaques (15 percent), the use of drugs that affected photosensitivity (15 percent), age less than 20 years (9 percent), skin type I (9 percent), and liver disease (6 percent). The remaining 16 (24 percent) were treated with PUVA. The main indication for this therapy was the severity of the disease (15 percent), followed by the presence of skin type IV (9 percent). CONCLUSIONS: Prescriptions of narrowband UVB exceeded those of PUVA because of fewer contraindications and fewer possible side effects, and because it was a more practical option.

Asunto(s)

Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Fototerapia/métodos , Prescripciones/estadística & datos numéricos , Psoriasis/terapia , Terapia PUVA/estadística & datos numéricos , Fototerapia/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Terapia Ultravioleta/estadística & datos numéricos , Adulto Joven

RESUMEN

Antecedentes: en la actualidad existen muy pocos datos en la literatura acerca de la evolución a largo plazo de los pacientes con micosis fungoides (MF) en tratamiento con PUVA. (fotoquimioterapia con radiación ultravioleta tipo A). Objetivos: Conocer las características epidemiológicas y clínicas de los pacientes con diagnóstico de MF en tratamiento con PUVA en el servicio de dermatología del CES-Sabaneta, y determinar qué impacto tiene la terapia de mantenimiento en la prevención de recaídas y en la sobrevida. Métodos: se realizó un estudio descriptivo y retrospectivo, con los pacientes con diagnóstico de MF desde abril de 1997 hasta junio de 2005.

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Background: PUVA is considered first line therapy in early stages of mycosis fungoides. There are few reports in the literature about the long term follow up of these patients. Objective: to describe the epidemiology and clinical characteristics of patients with early stages of mycosis fungoides in PUVA therapy, in the Dermatologic Center CES-Sabaneta. We wanted to know the relationship between PUVA therapy and patient’s evolution, response to treatment, survival rates, relapse and adverse effects. Methods: a single center, retrospective, descriptive study was done. We included all patients with confirmed diagnosis of mycosis fungoides, who assisted PUVA therapy between April of 1997 and June of 2005.

Asunto(s)

Humanos , Micosis Fungoide/diagnóstico , Terapia PUVA/métodos , Terapia PUVA/tendencias , Terapia PUVA , Medicina Interna

RESUMEN

Se estudiaron 32 pacientes con psoriasis en placas que asistieron a la consulta de dermatología del CES en Medellín, Colombia, en el 2003, remitidos para tratamiento con psoralenos – UVA (PUVA). Se les administró PUVA más calcitriol tópico en el lado izquierdo del cuerpo y al lado derecho solo PUVA, durante 8 semanas. El objetivo principal del estudio fue determinar la eficacia del tratamiento de la combinación de PUVA más calcitriol con respecto a la monoterapia con PUVA, mediante la comparación de los tiempos promedio de aclaramiento de las dos intervenciones, así como la diferencia en las proporciones de recuperación en cada grupo y la valoración de los efectos secundarios desencadenados por cada uno de los tratamientos. Se observó un aclaramiento más rápido en la segunda y cuarta semana del lado que recibió tratamiento con calcitriol más PUVA, lo que llevaría a una menor exposición a la luz UVA. La diferencia en la disminución del Índice por área y severidad de la psoriasis (PASI) fue estadísticamente significativa. La terapia de combinación con los análogos de la vitamina D y la sustancia activa como tal, el calcitriol más PUVA, producen una respuesta clínica más rápida y efectiva que el PUVA solo.

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Psoriasis is a frequent dermatologic disease and there are many different therapeutic approaches for its management. The goal of this trial was to compare the efficacy of combined psoralen and ultraviolet A light (PUVA) plus topical calcitriol, to PUVA monotherapy, and to study the average time for clearing of the lesions in both groups. Patients and methods: Thirty two consecutive patients with plaque psoriasis, referred for PUVA therapy, to a dematology reference center (CES University department of Dermatology) were studied in 2003. They received the combination of PUVA plus topical calcitriol on the left side of the body, and PUVA on the right side only, for eight weeks. Medical evaluation was performed every 15 days with measurement of the Psoriasis Area and Severity Index (PASI), and photographic followup. Results: Improvement was faster on the side treated with calcitriol and PUVA, than on the side treated only with PUVA alone; and PASI diminished significantly on the side treated with combination therapy (p).

Asunto(s)

Humanos , Calcitriol , Psoriasis/diagnóstico , Psoriasis/terapia , Terapia PUVA

RESUMEN

La psoriasis es una enfermedad inflamatoria crónica que afecta tanto a hombres como a mujeres, y puede presentarse a cualquier edad, con una prevalencia de 1 - 3% de la población mundial. Existen múltiples modalidades terapéuticas, divididas en medicamentos tópicos y sistémicos dentro de los cuales se encuentra la fototerapia. Objetivo: establecer la efectividad de los psoralenos orales más la luz ultravioleta A versus la luz ultravioleta B de banda estrecha, en el tratamiento de la psoriasis moderada a severa. Para ello se realizó un metanálisis con base en la revisión sistemática de la literatura que incluyera ensayos clínicos aleatorizados que compararan la efectividad del tratamiento con PUVA versus el tratamiento con NB-UVB. Todos los estudios fueron evaluados por tres investigadores, tanto en la calidad metodológica como en los criterios de inclusión y exclusión, y sólo se incluyeron aquellos ensayos clínicos con calificación mayor o igual a 1++ según la escala de Jadad. Resultados: La búsqueda arrojó 110 artículos, los cuales en su mayoría fueron descartados debido a que no cumplían los criterios de inclusión propuestos, quedando solo tres estudios en el análisis final: Yones et al, Markham et al y Gordon et al, y en los cuales se encontraron diferencias estadísticamente significativas a los tres y seis meses de seguimiento a favor de PUVA, pero con poco peso estadístico. Conclusiones: La terapia con PUVA mas psoraleno oral tiene tendencia a mostrar mayor efectividad que la terapia NB-UVB, pero el reducido número de estudios impide establecer una conclusión de forma definitiva.

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Psoriasis is a chronic inflammatory condition with a worldwide prevalence of 1-3% that affects both men and women and may presents at any age. Multiple therapeutic modalities exist: topical and systemic medications within which phototherapy is found. Objective: to establish the efectiveness of oral psoralens plus ultraviolet A light versus narrow band ultraviolet B light in the treatment of moderate to severe psoriasis. Methods: A meta-analysis based on the systematic review of literature was performed. All clinical studies included were randomized clinical trials that compared the effectiveness of PUVA vs NB-UVB treatment. All studies were evaluated by three researchers, both according to the methodological quality and to the inclusion and exclusion criteria. Only those clinical trials with a score equal to or greater than 1++ according to the Jadad scale were included. Results: The search found 110 articles, of which the majority were discarded due that they did not meet the inclusion criteria proposed, leaving only three trials for the final analysis: Yones et al, Markham et al y Gordon et al. These trials compared the effectiveness of oral psoralen PUVA versus NB-UVB. Statistically significant differences were found at three and six months follow up in favor of PUVA treatment, but having a low evidence weight. Conclusions: PUVA with oral psoralen tends to show a higher efectiveness than NBUVB therapy, but the reduced number of studies does not allow for a definitive conclution.

Asunto(s)

Fototerapia/instrumentación , Fototerapia , Metaanálisis como Asunto , Psoriasis/diagnóstico , Psoriasis/terapia , Terapia PUVA , Furocumarinas

RESUMEN

Descreve-se um caso de telangiectasia macularis eruptiva perstans em paciente do sexo masculino de 18 anos com história de máculas telangiectásicas disseminadas por tronco e membros. O sinal de Darier foi positivo. O exame histopatológico mostrou infiltrado inflamatório mononuclear, com acúmulo de mastócitos ao Giemsa. A telangiectasia macularis eruptiva perstans deve ser considerada em pacientes que apresentem lesões telangiectásicas de aparência e distribuição atípicas com início na infância.

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We report a case of telangiectasia macularis eruptiva perstans in an 18-year-old male patient who developed multiple erythematous maculae on the trunk and limbs. Darier’s sign was positive. Histopathology revealed mononuclear cell infiltrate and increased number of mast cells identified with Giemsa staining. Telangiectasia macularis eruptiva perstansshould be considered in patients with telangiectatic lesions of atypical appearance or distribution which start in childhood.

Asunto(s)

Niño , Femenino , Humanos , Pénfigo Familiar Benigno/patología

RESUMEN

Na patogênese do vitiligo tem-se enfatizado o papel das células T citotóxicas. Identificadas pelo antígeno linfocitário cutâneo (CLA), essas células já foram descritas no sangue de pacientes com outras dermatoses e podem ser depletadas pela fototerapia concomitantemente à melhora clínica. Descreve-se caso de vitiligo generalizado com melhora clínica expressiva após Puva, no qual houve redução de 25% dos linfócitos T CD8+-CLA+ circulantes.

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The role of cytotoxic T cells (CD8+) has been emphasized in the pathogenesis of vitiligo. This cell population, identified by a skin homing molecule (cutaneous lymphocyte associated antigen Â- CLA), has been described in patients with other dermatoses and can be reduced with phototherapy. The authors present the case of a patient with generalized vitiligo and clinical recovery after PUVA parallel to a 25% reduction in CD8+-CLA+ T cells in the peripheral blood.